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39% van transmannen en non-binaire mensen had spijt over vruchtbaarheidskeuzes na verwijdering van voortplantingsorganen

Keuzes voor vruchtbaarheidsbehoud en beslissingsspijt na genderbevestigende operatie bij transmannen of non-binaire personen

EnquêtesDetransitie & spijtChirurgie
Authors
Austin Johnson, Asha B. McClurg, Janine Baldino, Rajeshree Das, Erin T. Carey
Journal
F&S Reports
Year
2024
Source
https://doi.org/10.1016/j.xfre.2023.12.002

Summary

Surgeons at the University of North Carolina surveyed trans men and nonbinary people who had their womb and/or ovaries removed. They asked about regret over the fertility decisions made before surgery, not regret about the surgery itself. Of 57 people who replied, about 2.5 years after surgery, 39% had at least mild regret and 16% moderate to severe regret. Nearly everyone had turned down seeing a fertility specialist, most often because they did not want children at the time, and no one froze eggs or embryos. Records said all had been given fertility advice, but only 30% remembered it, and those who felt the advice was poor had more regret. More people rated having a family in future as important after surgery than before. With only half replying, one clinic and short follow-up, the true level of regret is uncertain and could be higher or lower.

Key findings

  • 57 van de 112 transmannen en non-binaire mensen (51%) die in 2014 tot 2023 aan de University of North Carolina hun voortplantingsorganen lieten verwijderen, beantwoordden de enquête, gemiddeld ongeveer 2,5 jaar na de operatie.
  • Op een beproefde spijtvragenlijst had 39% spijt over de keuzes over vruchtbaarheid die ze vóór de operatie maakten: 23% licht en 16% matig tot ernstig (scores tot 85 van de 100).
  • Medische dossiers toonden dat iedereen vruchtbaarheidsadvies kreeg, maar slechts 30% herinnerde zich dat hun werd verteld over vruchtbaarheid of manieren om een gezin te stichten.
  • Dossiers toonden dat 97% een vruchtbaarheidsspecialist werd aangeboden, maar slechts 3 mensen (5,5%) accepteerden, en niemand ging door met het invriezen van eicellen of embryo's.
  • De meest voorkomende reden om nee te zeggen was destijds geen kinderen willen (68%), gevolgd door plannen om te adopteren, zorgen over het stoppen met testosteron, en angst dat zwangerschap de genderklachten zou verergeren.
  • Spijt was veel hoger bij mensen die het advies over de effecten op vruchtbaarheid slecht vonden (een typische score van 50 tegenover 0), en iets hoger bij wie het advies over vruchtbaarheidsopties slecht vond (12,5 tegenover 0).
  • Meer mensen vonden het hebben van kinderen of een gezin in de toekomst belangrijk ten tijde van de enquête dan vóór de operatie, wat suggereert dat opvattingen na de operatie kunnen veranderen.

Abstract

OBJECTIVE: To investigate the prevalence of decisional regret regarding preoperative fertility preservation choices after gender-affirming surgery or removal of reproductive organs.

DESIGN: Cross-sectional.

SETTING: University-based pratice.

PATIENTS: A total of 57 survey respondents identifying as transgender men or gender nonbinary with a history of gender-affirming surgery or removal of reproductive organs between 2014 and 2023 with the University of North Carolina Minimally Invasive Gynecology division.

INTERVENTION: Survey or questionnaire.

MAIN OUTCOME MEASURES: The prevalence and severity of decisional regret regarding preoperative fertility preservation choices were measured with the use of the validated decisional regret scale (DRS) (scored 0-100). Secondary outcomes included patient-reported barriers to pursuing reproductive endocrinology and infertility consultation and fertility preservation treatment.

RESULTS: The survey response rate was 50.9% (57/112). "Mild" to "severe" decisional regret was reported by 38.6% (n = 22) of survey respondents, with DRS scores among all respondents ranging from 0-85. Higher median DRS scores were associated with patient-reported inadequacy of preoperative fertility counseling regarding implications of surgery on future fertility or family-building (0 vs. 50) and fertility preservation options (0 vs. 12.5). No desire for future fertility at the time of fertility counseling was the most frequent reason (68.4%) for declining a referral to reproductive endocrinology and infertility for additional fertility preservation discussion.

CONCLUSIONS: Decisional regret regarding preoperative fertility preservation choices is experienced among transgender men or gender nonbinary persons after gender-affirming surgery or the removal of reproductive organs. Preoperative, patient-centered fertility counseling and fertility preservation treatments should be provided to reduce the risk of future regret.

Conclusion

Decisional regret regarding preoperative fertility preservation choices is experienced among transgender men or gender nonbinary persons after gender-affirming surgery or the removal of reproductive organs. Preoperative, patient-centered fertility counseling and fertility preservation treatments should be provided to reduce the risk of future regret. (Full text adds that care should include equitable access to family-building options in the context of decreasing access to gender-affirming care.)